It’s not difficult for sleep physicians to predict which patients are most likely to have sleep apnea. The latest study from researchers at the University of Wisconsin-Madison (UWM) confirms the patient profile, adding more evidence to the widely held belief that obesity is, at least in part, fueling a rise in sleep apnea.

Originally published in the American Journal of Epidemiology “Increased Prevalence of Sleep-Disordered Breathing in Adults”.

“There are probably 4 million to 5 million people who are more likely to have sleep apnea due to the obesity epidemic,” says Paul Peppard, PhD, assistant professor of population health sciences at UWM in an article by Traci Pedersen. “It’s certainly an uncalculated cost of the obesity epidemic, an epidemic of its own.”

Specific findings show a sizable spike in sleep apnea cases over the past two decades—as much as 55%. The study involved more than 600 adults, ages 30 to 70, who underwent sleep tests between 1988 and 1994—with some continuing to take part along with hundreds of new participants from 2007 to 2010.

Pedersen summarizes that among all groups, heavier people were much more likely than thinner people to suffer from sleep apnea. Peppard estimates that 80% to 90% of the increase in symptoms is due to the growth in obesity.

Click here for the study abstract.

The post More Research Links Obesity to Sleep Apnea appeared first on Sleep Diagnosis and Therapy.

Sleep physicians who recommend the pharmaceutical route to better slumber must always take side effects into account. The tradeoffs are usually worth it, but what if the tell-tale fogginess could be eliminated?

A Los Angeles Times article by Melissa Healy reports that an investigational drug that works on certain receptors in the brain, particularly the lateral hypothalamus where molecules called orexins are released, could help. The medication, dubbed DORA-22, is unlike existing hypnotic sedatives that “work on so-called GABA receptors, which are found throughout the brain. That makes them a relative blunderbuss in inducing sleep and often results in residual effects.”

Those residual effects prompted the FDA recently to order changes to the recommended dosing of Ambien, particularly for women and the elderly, among whom lingering cognitive effects have proved to be common.

The study (Read Abstract Here) “Orexin Receptor Antagonists Differ from Standard Sleep Drugs by Promoting Sleep at Doses that do not Disrupt Cognition” released this week in the journal Science Translational Medicine, demonstrated effectiveness in inducing sleep in rats and rhesus monkeys. “The researchers showed that the minimum effective dose of DORA-22 to induce sleep had no effect on the animals’ [lab animals]attention and memory performance after it was administered,” writes Healy. “In the case of the widely marketed hypnotics, the minimal dose to induce sleep also resulted in cognitive deficits.”

The drug’s originator, Merck, is asking the Food and Drug Administration to consider approval of a proposed sleep medication, called suvorexant, with a similar mechanism of action to that of the DORA-22 medication.

The post Can New Sleep Medication Get Out the “Foggy” Side Effects? appeared first on Sleep Diagnosis and Therapy.

How important is sleep? The evidence piles up every week, with UC Davis Sleep Laboratory researchers adding their wisdom in the February issue of American Journal of Physiology: Regulatory, Integrative and Comparative Physiology.

The new study “Longitudinal Sleep EEG trajectories indicate complex patterns of adolescent brain maturation” monitored brain waves of sleeping adolescents, documenting major changes in the brain as it “prunes away neuronal connections” and transitions from childhood to adulthood.

Read Abstract

“We’ve provided the first long-term, longitudinal description of developmental changes that take place in the brains of youngsters as they sleep,” said Irwin Feinberg, professor emeritus of psychiatry and behavioral sciences and director of the UC Davis Sleep Laboratory. “Our outcome confirms that the brain goes through a remarkable amount of reorganization during puberty that is necessary for complex thinking.”

The research also confirms that electroencephalogram, or EEG, is a powerful tool for tracking brain changes during different phases of life, and that it could potentially be used to help diagnose age-related mental illnesses. According to Science Daily, the research is the final component in a three-part series of studies carried out over 10 years and involving more than 3,500 all-night EEG recordings.

The new findings show that synaptic density in the cerebral cortex reaches its peak at age 8 and then begins a slow decline. The recent findings also confirm that the period of greatest and most accelerated decline occurs between the ages of 12 and 16-1/2 years, at which point the drop markedly slows.

“Discovering that such extensive neuronal remodeling occurs within this 4-1/2 year timeframe during late adolescence and the early teen years confirms our view that the sleep EEG indexes a crucial aspect of the timing of brain development,” said Feinberg.

The post Changes During Sleep Lead to “Complex Thinking” Capability in Young Adults appeared first on Sleep Diagnosis and Therapy.

A new study shows that sleep problems can be an early indicator of Alzheimer’s disease.

“Safety and Tolerability of the γ-Secretase Inhibitor Avagacestat in a Phase 2 Study of Mild to Moderate Alzheimer Disease” is published in JAMA Neurology.

Read Abstract.

Sleep disturbances are common in people with Alzheimer’s disease, but it wasn’t previously known prior to this study if they occur before cognitive symptoms begin. Washington University School of Medicine researchers were seeking to learn if poor-quality sleep is an early indicator of Alzheimer’s.

For the new study, they recruited 142 adults age 45 and older with no outward signs of cognitive problems. Researchers monitored their sleep for two weeks and also tested their cerebral spinal fluid to see if a molecule that indicates a buildup of beta-amyloid – regarded as the earliest identifiable stage of Alzheimer’s– was occurring in their brains.

They found that 32 people who had evidence of the molecule in their cerebral spinal fluid also had the poorest quality sleep of those in the study.

In the study’s conclusions, the researchers said they hoped their findings would stimulate more research into the area of sleep and amyloid disposition, and provide an even stronger motivation to identify and treat individuals with common sleep disorders, such as obstructive sleep apnea. Apnea causes people to briefly stop breathing and to sleep fitfully.

The study did not show that it is a certainty that people with beta-amyloid deposits will go on to develop Alzheimer’s disease.

The take-home message of this study is that if someone is having sleep problems they should go to the doctor because it could be an early indicator of Alzheimer’s disease, or it can indicate another problem like sleep apnea, which is correctable.

SOURCE: News Max Health

The post Sleep Problems may be an Early Indicator of Alzheimer’s appeared first on Sleep Diagnosis and Therapy.

Researchers at the University of Montreal examined a wide swath of literature, concluding that much of sleepwalkers’ behavior comes down to myth. For example, sleepwalkers sometimes remember what they have done on their night time sojourns.

Antonio Zadra, of the University of Montreal, worked with colleagues at the Centre for Advanced Studies in Sleep Medicine at the Hôpital du Sacré-Cœur de Montréal, with findings published in Lancet Neurology “”Somnambulism: clinical aspects and pathophysiological hypotheses” Read Summary

“In adults, a high proportion of sleepwalkers occasionally remember what they did during their sleepwalking episodes,” said Zadra via University of Montreal press release “Some even remember what they were thinking and the emotions they felt.”

Zadra concludes that the behavior of sleepwalkers is not simply a zombie-like automatic function. “There is a misconception that sleepwalkers do things without knowing why,” he said. “However, there is a significant proportion of sleepwalkers who remember what they have done and can explain the reasons for their actions.”

Both children and adults are in a state of so-called dissociated arousal during wandering episodes—with parts of the brain asleep, while other parts are awake. “There are elements of wakefulness since sleepwalkers can perform actions such as washing, opening and closing doors, or going down stairs,” added Zadra. “Their eyes are open and they can recognize people. But there are also elements specific to sleep: sleepwalkers’ judgment and their ability for self-thought are altered, and their behavioral reactions are nonsensical.”

Published in the JAMA Network “Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality “, a 155-patient study concluded “primary care was not clinically inferior to treatment at a specialist sleep center for improvement in daytime sleepiness scores.” According to an abstract, the primary outcome comparison was a 6-month change in Epworth Sleepiness Scale (ESS) score.

Both primary care and specialty groups brought ESS scores down to seven from roughly 12 in 6 months. The abstract concludes: “Among patients with obstructive sleep apnea, treatment under a primary care model compared with a specialist model did not result in worse sleepiness scores, suggesting that the two treatment modes may be comparable.”

Ching Li Chai-Coetzer, MBBS, PhD, of the Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, and colleagues write that “a simplified management strategy for obstructive sleep apnea based in primary care was not clinically inferior to standard care in a specialist sleep center.”

“Thus, with adequate training of primary care physicians and practice nurses, and with appropriate funding models to support an ambulatory strategy,” they continue via JAMA press release, “primary care management of obstructive sleep apnea has the potential to improve patient access to sleep services. This would be particularly beneficial for rural and remote regions, as well as developing nations, where access to specialist services can be limited.”

Source: JAMA Network

Patients with heart failure routinely suffer from insomnia, but does insomnia increase the risk of heart failure?

Researchers in Norway spent more than a decade studying the question, concluding that insomnia caused more than a three-fold increase in heart failure risk.

The study, “Insomnia and the risk of incident heart failure: a population study“ published online last week in the European Heart Journal, followed 54,279 people between the ages of 20-89 for an average of more than 11 years.

According to a summary prepared by the European Society of Cardiology, Dr Lars Laugsand, a post-doctoral fellow in the Department of Public Health, Norwegian University of Science and Technology, Trondheim, related heart failure risk “to three major insomnia symptoms, including trouble falling asleep, problems staying asleep, and not waking up feeling refreshed in the morning.”

Laugsand’s study found that persons suffering from insomnia “have increased risk of having heart failure. Those reporting suffering from all three insomnia symptoms simultaneously were at considerably higher risk than those who had no symptoms or only one or two symptoms.”

An abstract in the European Heart Journal details researchers’ conclusions that insomnia is specifically associated with an increased risk of incident heart failure. “If our results are confirmed by others and causation is proved,” write researchers, “evaluation of insomnia symptoms might have consequences for cardiovascular prevention.”

The authors also found a moderate risk increase related to individual insomnia symptoms. However, risk among those with “all three insomnia symptoms simultaneously” was particularly high even after adjustment for established cardiovascular risk factors and psychological distress.

Academia and mass media continued their convergence with the widespread reporting of new Surrey University research that concludes “getting too little sleep for several nights in a row disrupts hundreds of genes that are essential for good health.”

According to a recent report, tests on people who slept less than six hours a night for a week revealed substantial changes in the activity of genes that govern the immune system, metabolism, sleep and wake cycles—in addition to the body’s response to stress—suggesting that poor sleep “could have a broad impact on long-term wellbeing.”

Effects of insufficient sleep on circadian rhythmicity and expression amplitude of the human blood transcriptome
publishing in the Proceedings of the National Academy of Sciences recent Feb edition.

The text of the study’s abstract specifically states “insufficient sleep and circadian rhythm disruption are associated with negative health outcomes, including obesity, cardiovascular disease, and cognitive impairment.”

The changes, which affected more than 700 genes, may shed light on the biological mechanisms that raise the risk of a host of ailments, including heart disease, diabetes, obesity, stress and depression, in people who get too little sleep.

“The surprise for us was that a relatively modest difference in sleep duration leads to these kinds of changes,” said Professor Derk-Jan Dijk, director of the Surrey Sleep Research Centre at Surrey University, in the Guardian report. “It’s an indication that sleep disruption or sleep restriction is doing more than just making you tired.”

Previous studies have suggested that people who sleep less than five hours a night have a 15% greater risk of death from all causes than people of the same age who get a good night’s sleep.

Even low-end estimates of fatalities related to drowsy driving confirm that the problem exacts a tragic toll on the nation’s highways. According to the National Highway Traffic Safety Administration (NHTSA), 2.5% of fatal motor vehicle crashes (approximately 730 in 2009), and 2% of all crashes with nonfatal injuries (approximately 30,000 in 2009), involve drowsy driving.

Still other modeling studies suggest 15% to 33% of fatal crashes might involve drowsy drivers. Either way, the figures lend additional credence to efforts to get the trucking industry fully on board with additional testing and treatment for commercial drivers.

The latest data from the NHTSA and the Centers for Disease Control (CDC) show that fatalities and injuries are more likely in motor vehicle crashes that involve drowsy driving compared with non-drowsy driving crashes.

To assess the state-level self-reported prevalence of falling asleep while driving, CDC analyzed data from a set of questions about insufficient sleep administered through the Behavioral Risk Factor Surveillance System (BRFSS) during 2009–2010.

Among 147,076 respondents in 19 states and the District of Columbia (DC), 4.2% reported having fallen asleep while driving at least one time during the previous 30 days. Reports of falling asleep while driving were more common among adults who reported usually sleeping ≤6 hours per day, snoring, or unintentionally falling asleep during the day compared with other adults who did not report these characteristics.

Drowsy driving was associated with other sleep-related characteristics. Adults who reported frequent insufficient sleep, a daily sleep duration of ≤6 hours, snoring, or unintentionally falling asleep during the day reported drowsy driving more frequently than those who did not report those characteristics. Click here for the full CDC report.

Snoring is very prevalent in our society, and is considered by most to be simply a cosmetic nuisance. The position health coverage takes in denying claims to treat snoring lends further support to this common consensus; at least for our patients. Unfortunately, in light of the mounting literature data which suggests that this is not the case, we have to ask ourselves, “Benign snoring  … How Benign is it?

Literature data suggests that Obstructive Sleep Apnea seems to progress from snoring. The vibration associated with snoring has been shown to lead to “nervous lesions”; muscle tissue atrophy and denervation. The degree of these changes has been shown to increase with increasing snore severity. Sensory neurons have also been shown to be affected by these vibrations. Studies have shown us that increasing severity of OSA is related to increase in “vibration & cold detection thresholds”; suggesting an impairment in the sensory neurons necessary to maintain airway patency.

When muscle tissue is altered by vibrations associated with snoring, the airway narrows making it more susceptible to collapse. When the pharyngeal sensory nerves become impaired from these same vibrations, the dilation reflex intended to prevent airway collapse also becomes impaired. It is particularly interesting that these “vibration caused lesions” become more prevalent in individuals that have increasing levels of disease from snoring to OSA.

Literature data also suggests that snoring and OSA may be important risk factors for Carotid Atherosclerosis and Stroke. A study of One hundred and ten volunteers that underwent full polysomnography, snoring quantification, and femoral and carotid artery ultrasound demonstrated this relationship. These subjects were categorized as mild, moderate or heavy snorers. The results showed that     prevalence of carotid atherosclerosis increased with increase in snoring severity. This was not the case for femoral atherosclerosis.

It was concluded that heavy snoring significantly increases the risk of carotid atherosclerosis and that this risk is independent of other risk factors including      measures of nocturnal hypoxia and OSA severity. These findings have substantial public health implications for the management of carotid atherosclerosis and the prevention of stroke.

Literature data clearly suggests that snoring is a precursor to OSA and that increasing severity levels of snoring is associated with increasing risk of Carotid Atherosclerosis and Stroke. Yet, snoring is commonly considered by many to be of cosmetic importance only.

In summary, increasing severity of snoring has been associated with changes in airway tissues, which impair upper airway function and to arterial changes which increase susceptibility to Stroke. The next time we are dealing with “Benign Snoring …” we need to ask ourselves; “How Benign is it?”

John Viviano DDS